Breast cancer

Question 1

Outline the epidemiology of breast cancer.

Answer 1

Median age is 62

Question 2

Give some risk factors for breast cancer.

Answer 2

• age
• genetics
• diet
• endocrine factors
• previous radiation (radiation to thytoid or chest)
• Breast cancers are hormone responsive cancers*

Question 3

Outline the pathological types of breast cancer.

Answer 3

Ductal carcinoma

• invasive (most treated surgically)
• in situ

Lobular carcinoma (within breast lobules itself)

• in situ (rare) - LCIS is more likely to be invasive and more likely to develop into ANY breast ca (thus offer surveillance MRI studies, mannograms, can offer bilateral mastectomies - don’t just remove LCIS). Hence, make sure there is no multifocal breast ca on other side. IE IT IS NOT A PREDISPOSITION TO INVASIVE LOBULAR CANCER, BUT ANY CANCER.
• invasive

Mixed ductal/lobular - Hence, make sure there is no multifocal breast ca on other side.

Inflammatory breast cancer - more aggressive, skin ulcerated/bleeding, no mass typically. Presents with subtle changes eg abscess/mastitis thus delayed Dx common - Tx is radical surgery or chemo.

- Rarer histological subtypes of IDC: mucinous (layer of mucin seen by pathologists; jelly like substance in breast), tubular (tubules appearance), medullary (tends to be triple -ve, aggressive), papillary. Papillomas - benign, non-invasive but still do excision biopsy on papilloma to show its not invasive.

Mucinous + tubular = low grade cancers, good prognosis

Triple -ve ca = harder to manage